Baldness as heart attack risk factor?

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Should men have their hairline checked — along with their weight, blood pressure, and cholesterol — to assess their heart disease risk? That seems to be the message of a study published last Wednesday in the British Medical Journal Open, which found that men with severe baldness had as much as a 44 percent greater risk of developing heart disease over the course of 10 to 15 years than men with hair.

Men who had more severe baldness at the top of their head — especially if they hadn’t yet hit 60 — had the greatest increase in risk.

The findings aren’t new. Back in 2000, Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital, and her colleagues tracked more than 19,000 men over 11 years and found that male pattern baldness was associated with a 34 percent increased heart disease risk compared with men who had receding hairlines or no hair loss.

I asked Manson what she thought of the latest research, in which University of Tokyo researchers analyzed six studies involving nearly 37,000 men.

“These findings shouldn’t be a cause of alarm,” Manson said. “It’s a small association compared to other risk factors.” Cigarette smoking quadruples a person’s risk of heart disease, while having uncontrolled hypertension or high cholesterol doubles a person’s risk. Those 100 percent to 300 percent risk increases are much greater than the increased risk associated with male pattern baldness.

That should provide some comfort to the 30 percent to 40 percent of men who start thinking about comb-overs in middle age.

But Manson also believes that baldness could be an important heart disease risk marker and “may identify men who should be especially vigilant about controlling other risk factors like blood pressure, diabetes, or cholesterol.”

She said she wouldn’t, though, recommend additional screening tests such as a procedure to image the arteries for balding men who have no heart symptoms or other signs of heart disease.

At this point, researchers still don’t understand how baldness connects to clogged arteries. Previous studies have suggested that balding men are more likely to also have high blood pressure and insulin resistance, which often leads to diabetes. “Those relationships really do need additional study,” Manson said.

The missing link may be testosterone and other male sex hormones. Bald men tend to have higher levels of male hormone receptors in their scalp and also have higher levels of testosterone in their blood. An enzyme in the body converts testosterone to another hormone that causes hair follicles to shrink and wither, wrote the Japanese study authors. This same enzyme has been found to also interact with testosterone in the arteries, they added, which causes the buildup of plaque or atherosclerosis.

None of these statistical links, of course, prove that a predisposition to baldness causes heart disease or other ills. Nor do baldness treatments help the heart. “There’s currently no evidence that a treatment like minoxidil will affect heart disease risk in either a favorable or unfavorable way,” Manson said.

Ditto for hair transplantation.

Unfortunately, men who have inherited a baldness gene have little control over when or whether they’ll lose their hair. What they can control is lifestyle factors such as what they eat and how much they exercise, whether they smoke, and how well they comply with their doctor’s instructions to take cholesterol, diabetes, and hypertension medications.

“Research has found a tremendous reduction in heart disease risk in those who can control these established risk factors,” Manson said. “They can certainly help offset any increased risk associated with baldness, and that’s really where our emphasis should be at this point.”

78sman3: Deb, as you have indicated, this is not a new finding. High testosterone levels have been linked with baldness, and they had also been linked with heart disease. Studies linking heart disease to baldness muddy the issue because they imply a causality between baldness and heart disease which does not appear to exist.

debkotz responds: Yes, this wasn’t a new finding and it didn’t conclude causation, but I think confirmation studies are important. When several studies find the same link it may be time to sit up and take notice and at least do something for controllable risk factors like a sedentary lifestyle, smoking habit, or poor diet.

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